You may be interested in this booklet if…
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You feel that your eating might be causing you difficulties but
you are not sure if you have an eating disorder
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You think you might have an eating disorder and want to find
out more about this
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You are worried about someone who you think may have an
eating disorder
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You want to know more about eating disorders
What will this booklet do?
1. Help you to recognise an eating disorder.
2. Describe the effects of an eating disorder.
3. Help you to understand the things that cause an eating
disorder and the things that keep it going once it has got
started.
4. Help you think about whether you want to make changes.
5. Describe what the next steps could be if you want to change.
What is an eating disorder?
What we eat and how we look seem to have become hugely
important. Television, magazines and books are full of
programmes about healthy eating and dieting. Yet there are also
lots of adverts for fast food, snack foods and chocolate, often next
to pictures of very skinny and attractive models. No wonder many
people are confused about what it is okay to eat and not eat, and
that many people feel upset that they can’t live up to these ideal
images. No wonder that most women say they have been on a
diet at some point in their lives.
When worries about food, weight and shape get to the point
where they really affect your life, this is called an eating disorder.
This booklet can help you to think about how you feel about food
and your weight, and to help you think about how it might be
causing difficulties in your life. There’s lots of information in this
booklet, so you might want to read it a few times, maybe over a
period of time, to help you build up a picture of how you think and
feel about your eating, weight and shape.
These are some examples of the things that people with eating
disorders often say:
“I know I’m six and a half stone, but if I could just lose another half
a stone I’ll be happy.”
“I can’t stop thinking about food, I even dream about it.”
“Some days I’m really good, and I only have an apple all day. But
then when I start to eat at night I can’t stop. Sometimes I even
make myself sick. Then I promise myself that tomorrow will be
different, and I’ll try much harder. But tomorrow is always the
same.”
“I’m so ashamed. I’m an ugly fat pig. Eating loads of crisps, cakes
and chocolate helps me forget how bad I feel for a while. Food is
like my friend, it makes me feel better like nothing else can. But
then afterwards I look at myself in the mirror and just cry and cry.”
Types of eating disorder
The medical names and descriptions for the different types of
eating disorder are.
Anorexia
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Restricted eating, sometimes with episodes of bingeing or
purging.
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Severe loss of weight.
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Strong fear of becoming fat or gaining weight
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Loss of periods for females
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Low weight for height
Bulimia
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Repeated urges to overeat (binge) often on high calorie foods
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Repeated attempts to avoid gaining weight by making yourself
sick, using laxatives or diuretics(water tablets), over exercising
or extreme dieting (these are also called purging).
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Mood changes and self-esteem are overly linked to weight.
Binge Eating Disorder
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Eating large amounts of food (binges), often quickly and
without feeling hungry, or stopping when full
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Feeling ashamed and guilty after eating, often eating is done in
secret
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There is often a general increase in weight over time.
Some people have a mixture of symptoms and their problems
may change over time. Their eating problems are often called
Eating Disorders Not Otherwise Specified.
How do I know if I’ve got an eating disorder?
This questionnaire asks about the sort of difficulties people with
eating disorders experience and can give you an idea of how
serious your problems are. It will not tell you whether or not you
definitely have an eating disorder as it is only a rough guide. Think
about the last week and read each question, circling the number
on the right that most applies to you.
In the last week…
1. Have you been deliberately trying to restrict the amount of food
you eat to change your shape or weight?
Not at all
0
1
Slightly
2
3
Moderately
4
Markedly
5
6
2. Have you gone for long periods of time (8 hours or more)
without eating anything in order to change your shape or weight?
Not at all
0
1
Slightly
2
3
Moderately
4
Markedly
5
6
3. Have you had any periods of binge eating? (i.e. eating what
other people would regard as unusually large amounts of food
with a sense of having lost control over eating).
Not at all
0
1
Slightly
2
3
Moderately
4
Markedly
5
6
4. Have you had a definite fear that you might gain weight or
become fat?
Not at all
0
1
Slightly
2
Moderately
3
4
Markedly
5
6
5. Have you made yourself sick, taken laxatives, diuretics (water
tablets) or vigorously exercised as a way to control your weight or
to counteract the effects of eating?
Not at all
0
1
Slightly
2
Moderately
3
4
Markedly
5
6
6. Has your weight or shape influenced how you think about
(judge) yourself as a person?
Not at all
0
1
Slightly
2
Moderately
3
4
Markedly
5
6
Total Score
Scoring on one item alone wouldn’t normally suggest you are
likely to have an eating disorder, but the more items you score on
the more likely this is.
1–12 Low level of difficulties – Work through this booklet &
consider some of the self-help references at the end of the
booklet.
13–24 Moderate level of difficulties – Work through this booklet,
but you may also wish to consider seeking professional help.
24–36 High level of difficulties – You may benefit from seeking
professional help as soon as you feel able.
What causes people to get an eating disorder?
There is no simple answer to this question as there can be lots of
different things that make people develop an eating disorder.
Eating disorders affect men and women of all ages, races and
backgrounds. While eating disorders appear to be about food and
weight they actually occur for a complex set of reasons. Below are
some of the things that combined together can trigger eating
disorders.
‘Ideal’ images from society and the media
In western society, the ‘ideal’ woman is often
shown as unrealistically young, slim and
physically attractive. Men are also encouraged to
be muscular and slim. Camera tricks, lighting and
the use of body doubles can make us think that the
people on TV and in films and magazines are
much more slim and ‘perfect’ than they are in
reality. Fashion magazines and designers use
‘waif’ models suggesting that beauty and glamour
is all about looking painfully thin. The reality is
different. Few people look like these models
without starving themselves but there is still a
pressure to try to achieve these looks.
Prejudice about fat people
People can think that if someone is fat they must also be being
lazy, stupid and ugly. This is, of course, completely untrue. But it
can increase people’s fear of becoming fat.
Fatness has also become very linked to unhealthiness and while
size can affect people’s health, it is a person’s level of fitness that
is more important. People who are overweight but exercise can
be much fitter and healthier than very slim people who do no
exercise. In fact yo-yo dieting is really bad for your health.
Independence and control
At times when people are struggling to be in control of their lives,
or to manage on their own, controlling food and eating can give
them a feeling that at least they are controlling something in their
life. It can also distract them from other worries.
Low self-esteem and lack of confidence
People with eating disorders often don’t feel very good about
themselves generally, and tend to focus on one small area of their
life, such as weight and shape, as a way of boosting some sense
of self esteem. For example they might think that losing weight will
make them feel more confident and attractive.
Perfectionism and unreal expectations
People with eating disorders often set themselves very high
standards to achieve. These can include high standards about
how much to eat, what weight to be and what shape to be. People
can focus on controlling their weight as one way to try to be
‘perfect’. When these goals are not realistic they are bound to fail,
and failing only makes them feel worse. Some people also have
rigid rules about staying in control of their emotions and not
showing how they feel. They can try to use food to deal with
difficult emotions rather than talking about them.
Stress, change or difficult feelings
Eating disorders often start in people’s
teens and twenties when there are lots
of changes in their bodies, their
feelings and their sexuality. Other
people might be facing exam or work
pressure, relationship problems,
losses or difficult decisions about the
future. Some people find these
changes too difficult to cope with and
an eating disorder may start as a way of
coping with some of the fears about
these changes. For example eating
disorders can often block out or mask
difficult emotions or negative feelings.
Trauma
Upsetting events like death, divorce, bullying, rape or childhood
abuse can produce overwhelming negative feelings, affect your
self-esteem and make you feel as if things are out of your control.
All of these things can be underlying causes of eating disorders.
Family expectations and attitudes to each other
Sometimes, if a family worries a lot about a son or daughter, and
likes to be very protective, a person can grow up with the
message that they will be no good at controlling their life
themselves. Focusing on controlling their weight can be a way of
feeling good at something.
Sometimes if a family has difficulty sorting out arguments a child
may feel trapped in the middle, and they may realise that when
their family is focused on worrying about the eating disorder they
don’t argue as much. This might make them worried about
starting to eat again.
If you have a problem with your eating ...
Think about all of the factors that have contributed to you
developing an eating disorder. List them below to help you
understand how your eating disorder developed.
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What beliefs make people at risk of getting an eating
disorder?
All the things described in the last section can affect the way you
think about yourself and other people and your beliefs about the
world. They can also affect your beliefs about food and weight.
These are some examples of the sort of beliefs you might develop
from these experiences:
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I need
to be in control…(and my eating disorder gives me
control)
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I need to be perfect for people to love me…(and if I lose weight
I’ll be perfect)
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If I’m thin I’ll be happy
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People are cruel…(& when I’m upset eating makes the bad
feelings go away)
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The world is a scary place that I can’t deal with…(at least I can
control my eating)
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I am disgusting…(and if I can be thin then I’ll feel better about
myself)
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I can’t cope on my own…(and if I’m ill people can’t expect me to
cope)
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I deserve to be punished…(and making myself sick is a way of
doing this)
Try to think about how your beliefs have been affected by what
has happened to you, and fill in the box below:
I am ..........................................................................................
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People are ...................................................................................
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The world is .................................................................................
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My body is ....................................................................................
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If I am thin then .............................................................................
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If I put weight on then....................................................................
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What are the effects of eating disorders?
It is helpful to think of an eating disorder as something that both
‘gives’ and ‘takes’. It is important to think about both when it
comes to understanding and treating an eating disorder. As you
have seen from the previous section, eating disorders don’t just
come out of the blue. There are often lots of reasons why a person
develops an eating disorder, but all of the reasons share
something in common – they cause people to feel distressed and
often out of control or unable to cope. When faced with these
feelings people look for something to help them manage.
Controlling ones eating can feel like it helps people to manage. To
the person with the eating disorder, the things that it can ‘give’
include:
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Feeling more in control
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Complements and positive feedback for weight loss
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Constant thoughts about food which block out other
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distressing thoughts
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A way of asking for help
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What seems like a solution to weight control
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Eating to take your mind off other problems
People do the best they can when things are difficult, and
sometimes changing their eating pattern can help in the short
term. The trouble is that once an eating disorder has developed
other things come into play, which create negative consequences
and additional problems for the person. Some of these are
outlined on the next few pages.
1. Changes to your metabolic rate
When you starve yourself of food, after a while it gets hard to
resist eating. Some people argue that for every diet, there is an
equal and opposite binge”. In other words, diets or periods of
starving yourself do not come for free. The cost is that they simply
cause people to rebel, and when they do, they end up usually
gaining more weight than they ever lost. Why is this? Basically it is
because of an in-built mechanism left over from prehistoric times,
to try to reduce the risk of people dying from starvation when food
was scarce. It works like this:
When you starve yourself over a period of time, by not eating at all
or by following a really strict diet, your body starts to react like it
would if you were stranded in the desert with no way of getting
food. It slows down your metabolic rate so that the food you eat
can be conserved for as long as possible. It also sends messages
to your brain to make you think about food a lot with the hope that
this will keep food on your mind so you will find food and eat
sooner rather than later.
When you do eat, your body wants to get as much food as it can,
in case there is another ‘starvation’ period coming, and so your
body encourages you to eat lots of food (called a binge). In case of
a second period of starvation it keeps your metabolic rate on
‘slow’ so you do not burn up this food as quickly as you would
normally. This can last for several months after you have stopped
starving or dieting. This is what can cause people to gradually
gain more and more weight.
2. Vomiting does not get rid of all the calories eaten.
After a binge many people feel guilty or disgusted with
themselves, and so they make themselves sick (called purging).
They think that being sick will get rid of all the food they have
eaten. Unfortunately this is not the case. Studies have shown that
vomiting after a binge only gets rid of approximately 30 to 50% of
all the calories eaten. So often people find they are also beginning
to gain weight, despite making themselves sick. Any sense of
relief is quickly replaced by feelings of loss of control, or failure.
You may then promise yourself that you are going to try even
harder not to eat from now on, and develop more rigid rules about
what it is okay to eat and what it is not okay to eat. But the more
you vomit the more your body craves food. This just brings you
back to the start of the cycle, and you find yourself stuck going
round and round it over and over again.
3. Laxatives and Diuretics don’t help people lose real
weight.
Laxatives and diuretics work by getting you to go to the toilet more
often and so getting rid of fluid and waste. Neither has any effect
on the way calories are absorbed by the body and so they do not
lead to weight reduction. While in the short term you may weigh
less or have a flatter stomach, the changes are only temporary as
our bodies immediately start to react against this, leading to water
retention, which takes you right back to where you were.
Unfortunately laxative and diuretic abuse can also cause
increased bloating, constipation and potassium and sodium
deficiencies which affect how well our muscles work.
4. Avoiding going out or doing things
When people feel low and worried about how they look, they
sometimes avoid seeing their friends or doing the things they
used to enjoy. This not only makes them feel worse, and keeps
them from getting support, but also means that their self esteem
may get even worse as they have nothing else to feel good about
except losing weight.
5. Checking
People with an eating disorder can spend a lot of time weighing
themselves and examining their bodies. Sometimes this makes
them feel better, but often it just sets them off
thinking about their bodies even more, and feeling even
worse. Weighing yourself more than once a week is a bad
idea because it won’t give you an accurate picture of what
your weight actually is. Our weight changes all the time
depending on the time of the day, the time of the month, when you
last ate etc.
6. Changes to your health
As you may have started to realise, there are lots of different ways
in which an eating disorder can affect people. Changes to our
eating can also, unfortunately, have some medical
consequences to our bodies and health. Some of these are
discussed below. This list is not intended to frighten you or make
you feel bad, and for that reason we have not listed all of the
consequences of having an eating disorder. It is here though, to
help you to begin to see how and what your eating disorder might
be ‘taking’ from you. Remember too that most of these difficulties
will go away when you recover from your eating problems.
However, most of these symptoms can become worse with time,
so they shouldn’t be ignored.
We have listed the problems that people tell us bothers them the
most. Obviously not all of these things will affect you. Different
sorts of eating disorders affect people in different ways. If you are
concerned or interested in learning about other problems, you will
find more information in the self help books listed at the back of
the booklet. Or you can speak to your GP, or a recognised eating
disorder helpline (see end of booklet for further information).
How eating disorders affect your body
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Dry skin,
loss of skin colour, thinning or brittle hair and nails –
due to nutrition deficiency.
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Tooth decay – if you make yourself sick the acid from your
stomach begins to damage your teeth, increasing your
chances of tooth decay. Brushing your teeth after being sick
can rub the acid into your teeth even more. Instead it is better to
rinse your mouth with mouthwash or water.
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Face and body is bloated or swollen – this can be due to
bingeing, vomiting, laxative and/or diuretic use. Repeated
vomiting can also cause the glands around your face and
throat to swell, making you look ‘fatter’ in the face when this
isn’t really the case.
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Irregular or loss of periods for females, and in some cases
problems getting pregnant.
How eating disorders affect the way you feel
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Depression, mood swings, anxiety and irritability
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Low self-esteem
and poor body image – often people become
more withdrawn too
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Increased tiredness and sleep
problems
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Poor concentration and memory
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Loss of sex drive
These problems can be the result of nutrition deficiency and
reduced metabolic rate and will improve once your eating
improves. Our electrolyte balance (these are the chemicals that
are needed to make nerves and muscles work properly) is
affected by repeated vomiting, and this causes many of the
feelings described above. Once people stop vomiting this
imbalance will right itself.
Summary
When someone develops an eating disorder it is because at
the time it felt like it was a solution to the problems or feelings
that they had. It gave the person something helpful in difficult
times. Unfortunately after a while eating disorders can also
begin taking things from the person too. Although it can be
hard to think about these things, some of them can have
serious consequences. By trying to think about these things
openly and honestly it can help people to think about how to
regain control over their eating again or at the very least how to
minimise the potential damage that eating problems can
cause.
Do I want to change things?
Thinking about change can be a difficult thing, especially if it feels
like you don’t know how else to cope. It is very helpful to take
some time to think about the pros and cons of change though, so
that you can weigh up what you need to change to recover.
Making a list might help you to look differently at your current
situation.
Make a list of all the reasons why you might be tempted to keep
your eating disorder in the first column. Then use all the
information you can to list all the reasons you might want to
change in the second column. Afterwards look at both the
columns to help you decide what to do next.
Next steps
I don’t want to change
For some people, at some points in their life, the positives of using
an eating disorder to cope with life outweigh the negatives, and
they decide that they are not ready to change. If this is how you
feel, remember that if you do change your mind in the future, help
is available. You don’t need to keep coping in this way forever. If,
at some point in the future the costs of living with an eating
disorder start to outweigh the benefits, maybe you can return to
this booklet and work through it again.
I’m still not sure,
I think it could be difficult
If you have worked through this booklet and have started to
recognise you have a problem, you might be feeling quite scared,
or even trapped. On one hand you might feel that you know what
the consequences of your eating disorder are, and you are
worried about this. One the other hand you might feel that at least
the eating disorder is familiar. You know where you stand with it.
The idea of changing things may seem like a huge mountain to
climb, and you might feel hopeless that things can ever be
different. You might also be worrying about what people will think
when you tell them about your problem, and what therapy will
involve. If control has been important to you, or if you feel a lot of
guilt and shame, the idea of telling someone else about your life
may feel difficult.
Therapists working with people with eating disorders understand
that the process of change can be difficult, and will work with you
to put together a treatment plan that balances what suits you best
and what keeps you safe, with what you can manage at that time.
Taking the step of seeking help can be hard. If the thought of going
for help fills you with dread, remember that you don’t have to go
back a second time unless you want to. Use the first sessions as a
chance to find out what is on offer and to ask questions, so that
you can decide whether or not you want to accept the help.
If you don’t want to seek help, there are also a number of very
good self-help books that can offer lots of practical advice and
strategies for making changes to your eating.
Some of these books are listed at the back of this booklet.
I want to change
Taking the step of seeking help can be hard, and sometimes it
takes more than one attempt to get the help you need.
A good place to start is to talk to your GP. If your problems are still
in the early stages, they may be able to give you some more selfhelp information like this to work through. There are also some
self help books that are listed overleaf which may be a good place
to start if your physical health is not too bad and you are not losing
weight too quickly.
Your GP may also suggest a referral for some more specialist
help. This may involve individual, family or group therapy
depending on what you need. A therapist will help you to develop
your understanding of your eating disorder and help you to
recover.
There are also voluntary organisations specifically set up for
people with eating disorders. Often these have telephone
information or helplines that you can call.
Remember that wherever you go for help it’s up to you to decide
whether you think the help on offer is for you. Don’t be afraid to
ask questions if you are offered an ‘assessment’ appointment.
This appointment is for you to assess the help on offer as much as
for the person you see to assess your problems.
Good luck whatever you decide.
Self help books
The Psychology of Eating
Jane Ogden (2002). Routledge.
Written by a psychologist, this book examines the reasons why so
many women diet and have body dissatisfaction; and explains
why diets don’t work.
Bulimia Nervosa. A Guide to Recovery.
Peter Cooper (1993). Robinson Publishing.
Offers practical advice to help people regain control over their
eating.
Getting Better Bit(e) by Bit(e). A Survival Kit for Sufferers of
Bulimia Nervosa and Binge Eating Disorders.
Ulricke Schmidt & Janet Treasure (1993). Lawrence Erlbaum.
A self-help treatment approach.
Overcoming Binge Eating.
Christopher Fairburn (1995). Guildford Press.
Information on binge eating plus a self help program.
Overcoming Anorexia Nervosa
Christopher Freeman (2002)
Information on anorexia nervosa plus a self help program.
Anorexics on Anorexia
Shelley (2000). Jessica Kingsley Publishers
17 women and 2 men write about their own experiences of
anorexia and highlight how their disorders began and what kept it
going. This book may also help families and friends to understand
how it feels to suffer from anorexia.
Carers Guide to Eating Disorders
Eating Disorders Association (2002).
Passing on their experiences, this book is written based on carer
accounts of hoe to help other families and friends manage eating
problems. A very clearly written, well signposted book, easy to dip
in and out of.
Organisations and contacts
The Eating Disorders Association (EDA)
First Floor, Wensum House, 103 Prince of Wales Rd,
Norwich, NR1DW
General enquiries: 01603 619090
National Helpline: 8.30am–8.30pm weekdays. 0845 6341414
Website: www.edauk.com
Email: [email protected]
This is a voluntary organisation that provides advice, support and
training to individuals with eating disorders, their carers, and the
professionals working in this field wherever you live in the UK.
The Northern Initiative on Women and Eating (NIWE)
1 Pink Lane, Newcastle upon Tyne. 0191 221 02333
A voluntary organisation which runs groups for sufferers, and
offers a telephone helpline. Also provides training to
professionals.
Samaritans 0845 7909090
Confidential 24 hour telephone counselling and support for any
difficulties
Useful numbers
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Samaritans 0845 790 9090
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MIND Information Line: 0161 272 8205, weekdays only 10:30am - 2pm
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Crisisline:
0808 808 2007 (textphone 0808 808 2117) every day, 3pm to
midnight. Free and confidential.
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Crisispoint: 0161 225 9500, for help with crisis accommodation, personal
support and daytime telephone contact:
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42nd Street: 0161 832 0170, range of services for young people aged 14-25
experiencing stress and mental health problems. Monday, Thursday & Friday
12.30-4.30pm
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Hearing Voices Network Helpline: 0845 122 8642
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NHS Direct: 0845 4647, 24 hours a day
For a range of local self help groups and services, contact Self Help Services on
08770 777 7832.
For information and advice about anxiety, panic and phobia problems, contact
Anxiety UK on 08444 775 774.
Visit your local library Health Information Point for information about mental health.
For easy access to a range of websites about mental health and local services, try the
following websites:
www.mhim.org.uk
www.mind-in-manchester.org.uk
Manchester Public Health Development Service
© Copyright Newcastle, North Tyneside and Northumberland Mental Health NHS Trust